Provider Demographics
NPI:1407381569
Name:BARDON, BRITTANIE (APN)
Entity Type:Individual
Prefix:
First Name:BRITTANIE
Middle Name:
Last Name:BARDON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 BENCHMARK CENTRE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2038
Mailing Address - Country:US
Mailing Address - Phone:618-624-9970
Mailing Address - Fax:618-624-9973
Practice Address - Street 1:4941 BENCHMARK CENTRE DR
Practice Address - Street 2:STE 100
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2038
Practice Address - Country:US
Practice Address - Phone:618-624-9970
Practice Address - Fax:618-624-9973
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015930363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics